Hypertension

On thursday we discussed an interesting patient with possibly autonomic dysreflexia, possibly due to a prior cord injury. This led to an interesting discussion of hypertensive urgency and its management.

Understandably, on internal medicine we often focus on hypertensive urgencies (typically >180/110 with no impending progressive end-organ damage) and emergencies (uncontrolled BP with acute progressive end-organ damage) because they are what we manage as an inpatient. Here is a recent review article on the management of these entities.

However, in the ambulatory setting we are often asked to initiate or modify ongoing antihypertensive therapy, and it is important for us to understand the guidelines as well as special situations in which certain agents are more evidence-based than others. Here is a summary of the most recent US guidelines, and here are the more recent Canadian Hypertension Education Program 2009 guidelines.